Provider Demographics
NPI:1376623298
Name:MILFORD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MILFORD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:I
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-761-4000
Mailing Address - Street 1:511 FIRST ST
Mailing Address - Street 2:PO BOX 747
Mailing Address - City:MILFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68405
Mailing Address - Country:US
Mailing Address - Phone:402-761-4000
Mailing Address - Fax:402-761-4005
Practice Address - Street 1:511 1ST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NE
Practice Address - Zip Code:68405-9701
Practice Address - Country:US
Practice Address - Phone:402-761-4000
Practice Address - Fax:402-761-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025262300Medicaid
NEDD9893OtherRR MEDICARE
NE099693Medicare ID - Type Unspecified
NE10025262300Medicaid